When Tiger Woods took first place at the 2018 Tour Championship recently, it was his first major win in more than five years.
In April 2017, Woods underwent a lumbar spinal fusion surgery to relieve the debilitating back pain that had forced him to drop out of the sport in which he’s considered one of the greatest golfers of all time. Before his lower spine fusion, Woods said playing golf was the furthest thing from his mind.
“I was beyond playing,” he told Bob Harig, a senior writer at ESPN.com. “I couldn’t sit. I couldn’t walk. I couldn’t lay down without feeling the pain in my back and my leg. That was a pretty low point for a very long time.”
Spinal fusion surgery has been around for more than 50 years. However, recent developments in minimally invasive techniques, computer navigation and robotics have made it less invasive, safer and more precise. Newer technology also reduces the need for repeated X-rays during surgery, which decreases radiation exposure for the patient and the attending surgical staff. Recovery is quicker and outcomes are much better than in years past.
Spinal fusion surgery welds together two or more vertebrae in the spine to reduce motion in the section that causes pain from arthritis, injury, disease or degeneration. Each procedure is slightly different depending on the patient’s individual condition, but typically the surgeon will decompress the nerves and replace a damaged disc (discectomy) with a bone graft and a synthetic cage in order to re-establish a normal level of space between the affected vertebrae and the nerve channels. In Wood’s case, the fifth lumbar vertebra had slid slightly over the sacrum, a condition known as spondylolisthesis, and was corrected by fixating and fusing the fifth lumbar vertebra to the sacrum. In time, the vertebrae will heal into one solid piece.
Most cervical (neck) fusion cases can be performed on an outpatient basis, with patients recovering at home and moving about on the same day. Thoracic and lumbar spinal fusions for the mid and lower back usually require a hospital stay of two to four days, depending on the location and complexity of the condition. In addition to spinal fusion, a neurosurgeon may also recommend a procedure known as a laminectomy, during which damaged bone or tissue is removed.
Spinal fusion surgery is not the answer for everyone with back pain, however, and should only be considered after conservative treatments, such as NSAIDs (nonsteroidal anti-inflammatory drugs), physical therapy and injections have failed to provide lasting pain relief. Spinal fusion can treat a number of back and neck problems, including:
• degenerative disc disease;
• spinal deformity such as scoliosis or kyphosis curvature of the spine;
• broken or fractured vertebrae;
• infections; and
Depending on the nature and location of the spine disorder, neurosurgeons will use one of three approaches to perform the procedure. The anterior approach requires a small incision to be made through the front or side of the abdomen to reach the lumbar region or through the front of the neck to reach the cervical spine. With the posterior lumbar approach, a small incision is made in the middle of the lower back; posterior cervical fusion is performed through the back of the neck.
Patients tend to feel better in less time than it takes for the bone fusion to become solidly formed. Post-lumbar surgical patients should avoid bending or lifting until they are cleared by their surgeon. Most patients are off all pain medication by the beginning of week three and often return to work by week six. Full recovery from cervical fusion can take from three to six months. Lumbar fusion can take from six months to a year to heal completely.
If you experience prolonged back or neck pain that radiates down a limb, consult with a board-certified neurosurgeon to learn if spinal fusion is an option for you.
– Scott Simon, MD